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 Sara Hofmann
Oliver Müller
Matti Rossi (Eds.)

Designing for Digital

LNCS 12388

Transformation
Co-Creating Services with Citizens
and Industry
15th International Conference on Design Science Research
in Information Systems and Technology, DESRIST 2020
Kristiansand, Norway, December 2–4, 2020, Proceedings
Lecture Notes in Computer Science 12388

Founding Editors
Gerhard Goos
Karlsruhe Institute of Technology, Karlsruhe, Germany
Juris Hartmanis
Cornell University, Ithaca, NY, USA

Editorial Board Members

Elisa Bertino
Purdue University, West Lafayette, IN, USA
Wen Gao
Peking University, Beijing, China
Bernhard Steffen
TU Dortmund University, Dortmund, Germany
Gerhard Woeginger
RWTH Aachen, Aachen, Germany
Moti Yung
Columbia University, New York, NY, USA
More information about this subseries at http://www.springer.com/series/7409
Sara Hofmann Oliver Müller
• •

Matti Rossi (Eds.)

Designing for Digital

Transformation
Co-Creating Services with Citizens
and Industry
15th International Conference on Design Science Research
in Information Systems and Technology, DESRIST 2020
Kristiansand, Norway, December 2–4, 2020
Proceedings

123
Editors
Sara Hofmann Oliver Müller
University of Agder University of Paderborn
Kristiansand, Norway Paderborn, Germany
Matti Rossi
Aalto University
Aalto, Finland

ISSN 0302-9743 ISSN 1611-3349 (electronic)

Lecture Notes in Computer Science
ISBN 978-3-030-64822-0 ISBN 978-3-030-64823-7 (eBook)
https://doi.org/10.1007/978-3-030-64823-7
LNCS Sublibrary: SL3 – Information Systems and Applications, incl. Internet/Web, and HCI

© Springer Nature Switzerland AG 2020

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 Preface

Welcome to the proceedings of the 15th International Conference on Design Science

Research in Information Systems and Technology (DESRIST 2020). There has been a
surge of interest in design science research (DSR) in the last decade and DSR has
developed into a mature research paradigm. The goal of the design science research
paradigm is to extend the boundaries of human and organizational capabilities by
designing new and innovative constructs, models, methods, processes, and systems.
Scholars from different backgrounds – such as information systems, computer science,
data science, software engineering, energy informatics, medical informatics, and
operations research – are actively engaged in generating novel solutions to interesting
design problems. The theme of DESRIST 2020 was “Designing for digital transfor-
mation – Co-Creating Services with Citizens and Industry.”
The conference attracted different types of submissions, including completed
research, ongoing research, research-in-progress, and prototype papers. In addition, the
conference organized a PhD colloquium. DESRIST has brought together researchers
and practitioners from the private and public sector to the conference to discuss and
debate how to co-create services for citizens and industries. Participants engaged in all
aspects of design science research, with a special emphasis on the design of services for
digital transformation.
This year’s preparation and execution of the conference have been heavily influ-
enced by the COVID-19 pandemic. Originally planned to take place in June at the
University of Agder in Kristiansand, Norway, DESRIST 2020 was eventually held as a
fully digital conference during December 2–4, 2020. Authors of completed research
papers prepared a five-minute presentation, which was followed by an intensive
five-minute discussion. The research-in-progress and prototype contributions were
presented in an entertaining one-minute design science research slam. In addition,
interesting discussions took place during the two panel sessions on “Ethics in Design
Science Research” and “The Role and Impact of Design Research on Digital Trans-
formation.” While we lost some of the ad-hoc meetings and informal gatherings, we
managed to have much interaction and participation.
This volume contains 28 full research papers, 7 research-in-progress papers, and 9
prototype papers, which accounts for an acceptance rate of 47%. The contributions
span across the overarching topics of Digital Public Services, Data Science, Design
Principles, and Methodology.
We would like to thank all the contributors who have aided in making this year’s
conference a success. Our gratitude goes to the members of the Program Committee,
including associate editors and reviewers for their effort in preparing the conference,
and reviewing and selecting the accepted papers, as well as to the authors for
vi Preface

submitting their papers. A special thanks goes to the local organizers at University of
Agder for their preparation and their flexibility in these challenging times. The con-
ference was only possible with the help and contribution of you all.

December 2020 Matti Rossi

Oliver Müller
Sara Hofmann
 Organization

General Chairs
Bengisu Tulu Worcester Polytechnic Institute (WPI), USA
Gondy Leroy University of Arizona, USA
Soussan Djamasbi Worcester Polytechnic Institute (WPI), USA

Conference Chairs
Leif Skiftenes Flak University of Agder, Norway
Maung Kyaw Sein University of Agder, Norway

Program Chairs
Matti Rossi Aalto University, Finland
Oliver Müller Paderborn University, Germany

Panel Chairs
Margunn Aanestad University of Agder, Norway
Monica Chiarini Tremblay Raymond A. Mason School of Business, USA
Polyxeni Vasilakopoulou University of Agder, Norway

Doctoral Consortium Chairs

Devendra Bahadur Thapa University of Agder, Norway
Sandeep Purao Bentley University, USA

Prototypes Chairs
Amir Haj-Bolouri University West, Sweden
Leona Chandra Kruse University of Liechtenstein, Liechtenstein

Proceedings Chair
Sara Hofmann University of Agder, Norway

Industry Relations Chair

Carl Erik Moe University of Agder, Norway
viii Organization

Website
Amna Drace University of Agder, Norway

Program Committee
Abayomi Baiyere Copenhagen Business School, Denmark
Ahmed Abbasi McIntire School of Commerce, University of Virginia,
USA
Ahmed Elragal Luleå University of Technology, Sweden
Alexander Herwix University of Köln, Germany
Alexander Maedche Karlsruhe Institute of Technology, Germany
Andreas Drechsler Victoria University of Wellington, New Zealand
Arturo Castellanos Baruch College, USA
Brian Donnellan Maynooth University, Ireland
Christian Janiesch University of Würzburg, Germany
Daniel Beverungen Paderborn University, Germany
Dirk Hovorka The University of Sydney, Australia
Dominik Gutt Rotterdam School of Management, The Netherlands
Guido Schryen Paderborn University, Germany
Heiko Gewald Neu-Ulm University of Applied Sciences, Germany
Jan vom Brocke University of Liechtenstein, Liechtenstein
Jason Thatcher University of Alabama, USA
Jeffrey Parsons Memorial University, Canada
Jens Pöppelbuß Ruhr University Bochum, Germany
Jonas Sjöström Uppsala University, Sweden
Kathrin Figl University of Innsbruck, Austria
Kaushik Dutta University of South Florida, USA
Ken Peffers University of Nevada, USA
Konstantin Hopf University of Bamberg, Germany
Martin Matzner University of Erlangen-Nuremberg, Germany
Matthew Mullarkey USF Muma College of Business, USA
Matthias Söllner University of Kassel, Germany
Monica Chiarini Tremblay Raymond A Mason School of Business, USA
Munir Mandviwalla Temple University, USA
Netta Iivari University of Oulu, Finland
Oliver Müller Paderborn University, Germany
Rangaraja Sundarraj Indian Institute of Technology Madras, India
Richard Baskerville Georgia State University, USA
Robert Winter University of St. Gallen, Switzerland
Roman Lukyanenko HEC Montréal, Canada
Samir Chatterjee Claremont Graduate University, USA
Sara Hofmann University of Agder, Norway
Stefan Morana Karlsruhe Institute of Technology, Germany
Stefan Seidel University of Liechtenstein, Liechtenstein
Tuure Tuunanen University of Jyväskylä, Finland
 Organization ix

Reviewers

Abhinay Puvvala Steffi Haag

Aleksi Aaltonen Hanlie Smuts
Alexia Athanasopoulou Hedda Lüttenberg
Alfred Benedikt Brendel Hendrik Wache
Alfred Castillo Hossam Hassanien
Ali Sunyaev Hossana Twinomurinzi
Alois Paulin Hyung Koo Lee
Andrea Kayl James Wallace
Andreas Weigert Jan Holmström
Andy Nguyen Jan Niklas Dörseln
Anik Mukherjee Jan Pries-Heje
Anna Sigridur Islind Janine Hacker
Ann-Kristin Cordes Jan-Peter Kucklick
Arto Lanamäki Jasper Feine
Benedikt Berger Jingjing Li
Benjamin Sturm John Venable
Brent Kitchens Jonna Järveläinen
Casandra Grundstrom Joshua Peter Handali
Christian Bartelheimer Julian Prester
Christian Hovestadt Jörg Becker
Christian Kalla Kai Heinrich
Connor Esterwood Kai Klinker
Craig A. Horne Kai-Kristian Kemell
Daniel Szopinski Karin Elisabeth Väyrynen
Darwin Hale Karthikeyan Umapathy
David Harborth Leena Arhippainen
David Schuff Lena Otto
Debra Vander Meer Lina Bouayad
Denis Dennehy Louise Harris
Denis Edwards Mala Kaul
Dennis Kundisch Manoj Thomas
Dixon Prem Daniel Marcus Green
Djordje Djurica Marcus Rothenberger
Eli Hustad Maria Cucciniello
Elin Uppström Mariem Ben Rehouma
Elina Annanperä Marius Schmid
Elizabeth Sanders Markus Helfert
Erol Kazan Mary Tate
Esko Penttinen Matthew Caron
Florence Mwagwabi Maximilian Haug
Gerit Wagner Maximilian Roeglinger
Guohou Shan Mengcheng Li
Gustaf Juell-Skielse Michael Fruhwirth
x Organization

Michael Hausch Scott Thiebes

Michael Lee Sebastian A. Günther
Moutaz Haddara Sebastian Bräuer
Na Liu Sebastian Hobert
Nadine Ogonek Shane Mcloughlin
Niall Connolly Shawn Ogunseye
Nicola Staub Stefan Cronholm
Nicolai Bohn Stephan Aier
Ning Yang Sumita Sharma
Oliver Posegga Susanne Strahringer
Osmo Mattila Thomas Friedrich
Padmal Vitharana Thomas Schulz
Patrick Delfmann Tiemo Thiess
Patrick Zschech Till J. Winkler
Pengcheng Wang Tilo Böhmann
Per Rådberg Nagbøl Tim Rietz
Peter Fettke Tobias Brandt
Philipp Brune Tobias Manner-Romberg
Philipp Mazur Tobias Pauli
Philipp Zur Heiden Ulrike Lechner
Ralf Laue Veda Storey
Roman Rietsche Verena Wolf
Ron Deserranno William Baber
Ryan Murphy Xuanhui Liu
Sabine Klein Yomn Elmistikawy
Samuel Kießling Yunxuan Zhang
Sascha Lichtenberg
 Contents

Digital Public Services

Delivering Effective Care Through Mobile Apps: Findings

from a Multi-stakeholder Design Science Approach. . . . . . . . . . . . . . . . . . . 3
Monica Chiarini Tremblay, Maria Cucciniello, Rosanna Tarricone,
Gregory A. Porumbescu, and Kevin C. Desouza

Design of a Machine Learning System for Prediction of Chronic

Wound Management Decisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Haadi Mombini, Bengisu Tulu, Diane Strong, Emmanuel Agu,
Holly Nguyen, Clifford Lindsay, Lorraine Loretz, Peder Pedersen,
and Raymond Dunn

Designing a Real-Time Integrated First Responder Health and

Environmental Monitoring Dashboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Ann Fruhling, Margeret Hall, Sharon Medcalf, and Aaron Yoder

Designing Digital Community Service Platforms for Crowd-Based Services

in Urban Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Christian Bartelheimer, Verena Wolf, Nico Langhorst,
and Florian Seegers

Designing for Digital Government Innovation in Resource Constrained

Countries: The Case of Woredas in Ethiopia. . . . . . . . . . . . . . . . . . . . . . . . 42
Debas Senshaw and Hossana Twinomurinzi

Designing Transport Supporting Services Together with Users

with Intellectual Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Sofie Wass, Lise Amy Hansen, and Chris Safari

Intrinsic Motivation to Share Health Information: Design Guidelines

and Features for Patient Sharing Platforms . . . . . . . . . . . . . . . . . . . . . . . . . 68
Lina Bouayad, Monica Chiarini Tremblay, Hemant Jain,
and Carmelo Gaudioso

Technology Personalization in Health Applications for Patients

with Autism Spectrum Disorder: Artifact Design
and a Controlled Experiment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Lina Bouayad, Anol Bhattacherjee, Mavara Agrawal,
Spurthy Dharanikota, and Polina Durneva
xii Contents

The Suggestion of Design Theory Artefacts for e-Government

in South Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Romi Vidmar, Eduan Kotzé, and Thomas M. van der Merwe

Tutorbot: A Chatbot for Higher Education Practice . . . . . . . . . . . . . . . . . . . 93

Jonas Sjöström and Maritha Dahlin

Data Science

An OOV-Aware Curation Process for Psycholinguistic Analysis

of Social Media Text - A Hybrid Approach . . . . . . . . . . . . . . . . . . . . . . . . 101
Kun Liu and Yan Li

Codifying Interdisciplinary Design Knowledge Through

Patterns – The Case of Smart Personal Assistants . . . . . . . . . . . . . . . . . . . . 114
Ernestine Dickhaut, Andreas Janson, and Jan Marco Leimeister

Exploring Design Principles for Enterprise Chatbots: An Analytic

Hierarchy Process Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Jasper Feine, Martin Adam, Ivo Benke, Alexander Maedche,
and Alexander Benlian

Knowledge Visualization for Sensemaking: Applying an Elaborated Action

Design Research Process in Incident Management Systems . . . . . . . . . . . . . 142
Quintus van Wyk, Judy van Biljon, and Marthie Schoeman

Multi-interest User Profiling in Short Text Microblogs. . . . . . . . . . . . . . . . . 154

Herman Wandabwa, M. Asif Naeem, Farhaan Mirza, Russel Pears,
and Andy Nguyen

Design Principles

Design Principles Exposition: A Framework for Problematizing Knowledge

and Practice in DSR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Magnus Rotvit Perlt Hansen and Amir Haj-Bolouri

The Origins of Design Principles: Where do… they all come from? . . . . . . . 183
Sandeep Purao, Leona Chandra Kruse, and Alexander Maedche

Developing Design Principles for Digital Platforms: An Agent-Based

Modeling Approach: Research-in-Progress . . . . . . . . . . . . . . . . . . . . . . . . . 195
Marius Schmid, Kazem Haki, Stephan Aier, and Robert Winter

Knowledge Creation - A Perspective on the Development

of Design Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Sofie Wass and Carl Erik Moe
 Contents xiii

Towards a Method for Design Principle Development

in Information Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Frederik Möller, Tobias Moritz Guggenberger, and Boris Otto

Methodology

Considering Context in Design Science Research: A Systematic

Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Philipp zur Heiden

Having a Positive Impact with Design Science Research – Learning

from Effective Altruism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Alexander Herwix and Amir Haj-Bolouri

Integrating CCM4DSR into ADR to Improve Problem Formulation. . . . . . . . 247

Coquessa Jones and John R. Venable

Problematizing in IS Design Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

Peter Axel Nielsen

Validity in Design Science Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272

Kai R. Larsen, Roman Lukyanenko, Roland M. Mueller, Veda C. Storey,
Debra VanderMeer, Jeffrey Parsons, and Dirk S. Hovorka

Platforms and Networks

A Platform for Value Co-creation in SME Networks . . . . . . . . . . . . . . . . . . 285

Sarah Hönigsberg

A Typology of Digital Sharing Business Models: A Design Science

Research Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Maria J. Pouri and Lorenz M. Hilty

Building Scalable Blockchain Applications - A Decision Process . . . . . . . . . 309

Adrian Hofmann

Designing for Context Versus the Lock-in Effect of ‘Free’ Global Digital
Platforms: A Case of SMEs from Nigeria. . . . . . . . . . . . . . . . . . . . . . . . . . 321
Adedamola Tolani, Adebowale Owoseni, and Hossana Twinomurinzi

Making Cloud Service Selection Easy for SMEs: A Tool for Selecting
SaaS Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Raoul Hentschel, Marco Gercken, and Sebastian Leichsenring

Meta-requirements for Immersive Collaborative Spaces in Industrial

Workplace Learning: Towards a Design Theory . . . . . . . . . . . . . . . . . . . . . 339
Amir Haj-Bolouri, Thomas Winman, and Lars Svensson
xiv Contents

Smart Factory – Requirements for Exchanging Machine Data . . . . . . . . . . . . 347

Chiara Freichel, Anna Fuchs, and Peter Werner

The Design Towards a Collaborative Subscription Service:

The Case of the Finnish Newspaper Industry . . . . . . . . . . . . . . . . . . . . . . . 360
Erol Kazan and Tuure Tuunanen

Service Science

A Digital Twin for Safety and Risk Management:

A Prototype for a Hydrogen High-Pressure Vessel . . . . . . . . . . . . . . . . . . . 369
Alireza Jaribion, Siavash H. Khajavi, Mikael Öhman, Adriaan Knapen,
and Jan Holmström

Bridging the Architectural Gap in Smart Homes Between User Control

and Digital Automation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Lukas-Valentin Herm, Jonas Wanner, and Christian Janiesch

Designing a State-of-the-Art Information System for Air Cargo Palletizing . . . 382

No-San Lee, Philipp Gabriel Mazur, Christian Hovestadt,
and Detlef Schoder

Designing Effective Privacy Nudges in Digital Environments:

A Design Science Research Approach: Research-in-Progress . . . . . . . . . . . . 388
Torben Jan Barev, Andreas Janson, and Jan Marco Leimeister

Enabling Design-Integrated Assessment of Service Business Models

Through Factor Refinement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
Jürgen Anke

Engineering Industrial Service Systems: Design and Evaluation

of System-Oriented Service Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Clemens Wolff, Niklas Kühl, and Gerhard Satzger

Me, Myself and I - Supporting People with Intellectual Disabilities

Towards Self-determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Sofie Wass, Lise Amy Hansen, and Erlend K. Stuve

Please Tell Me What to Do – Towards a Guided Orchestration

of Key Activities in Data-Rich Service Systems . . . . . . . . . . . . . . . . . . . . . 426
Fabian Hunke, Stefan Seebacher, and Hauke Thomsen

PS3 – A Domain-Specific Modeling Language for Platform-Based Smart

Service Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438
Hedda Lüttenberg
 Contents xv

SISA News: Software to Support the Swedish Information

Systems Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
Jonas Sjöström

System-Wide Learning in Cyber-Physical Service Systems:

A Research Agenda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Dominik Martin, Niklas Kühl, Johannes Kunze von Bischhoffshausen,
and Gerhard Satzger

Author Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469

Digital Public Services
 Delivering Effective Care Through Mobile Apps:
Findings from a Multi-stakeholder Design
Science Approach

Monica Chiarini Tremblay1(B) , Maria Cucciniello2 , Rosanna Tarricone3 ,

Gregory A. Porumbescu4 , and Kevin C. Desouza5
1 William and Mary, Williamsburg, VA 23185, USA
Monica.tremblay@mason.wm.edu
2 University of Edinburgh Business School, Edinburgh EH8 9JS, UK
maria.cucciniello@ed.ac.uk
3 Bocconi University, 20136 Milan, Italy
rosanna.tarricone@unibocconi.it
4 Rutgers University, Newark, NJ 07102, USA
greg.porumbescu@rutgers.edu
5 Queensland University of Technology, Brisbane, Australia

kevin.c.desouza@gmail.com

Abstract. In this paper, we use a design science approach to develop a mobile

app for lung cancer patients that facilitates their interactions with their clinicians,
manages and reports on their health status, and provides them access to medical
information/education. This paper contributes to the information systems literature
by demonstrating the value of design science research to co-create solutions that
advance health care outcomes through technological innovations. The design pro-
cess engaged a diverse cast of experts and methods, such as a survey of oncologists
and cancer patients, a workshop, roundtables and interviews with leading patient
and clinician association representatives and focus groups, including two pan-
els each of clinicians and cancer patients. Our approach also develops actionable
knowledge that is grounded in evidence from the field, including design guidelines
that recapitulate what we learned from the design-testing-redesign cycles of our
artefact.

Keywords: Healthcare · m-Health · Cancer care · Value co-creation

1 Introduction

Mrs. Rossi1 found it difficult to describe how angry, depressed, and betrayed by her own
body she felt when she was initially diagnosed with lung cancer almost 3 years ago.
These feelings intensified once she began therapy.

1 The quotes are translated from Italian.

© Springer Nature Switzerland AG 2020

S. Hofmann et al. (Eds.): DESRIST 2020, LNCS 12388, pp. 3–14, 2020.
https://doi.org/10.1007/978-3-030-64823-7_1
4 M. C. Tremblay et al.

“When necessary, I would prefer to easily communicate with my clinician because

he’s the only one who really understands how I feel and explains what I should do
or expect. However, I know that he’s very busy and takes care of many patients. I
am embarrassed to call him whenever I feel like I need to speak to him”.

Mrs. Rossi was one of the many participants who we interviewed during this research.
Many of the patients we spoke with reflected upon numerous instances in which they
wished they could have had closer contact with their physician. Patients noted feeling
alone during this long and difficult journey. Given the demands on a physician’s time,
patients reported that they felt uncomfortable sharing updates on their condition or
requesting information because they did not want to be a nuisance. Patients also regularly
failed to measure key indicators (e.g., weight and temperature) due to the lack of real-
time and personalized reminders between hospital visits (which could be 21–30 days
apart). Thus, their ability to manage their care on a regular basis was limited.
The sentiments expressed by the cancer patients we interviewed are not surprising.
Research shows that care models that are successful at improving outcomes and reducing
costs succeed in enhancing patient and family engagement in self-care and coordinat-
ing care and communication among patients and providers [1]. For example, Singh,
Drouin [2] conducted a scoping review2 and found that self-management is essential to
caring for high-need, high-cost populations. Furthermore, Hong, Siegel [3] found that
successful care management programs 1) consider care coordination to be one of their
key roles, 2) focus on building trusting relationships with patients and their primary care
providers, 3) match the team composition and interventions to patient needs, 4) offer
specialized training for team members, and 5) use technology to bolster their efforts. In
general, patient understanding, trust, and clinician-patient agreement affect intermedi-
ate outcomes (e.g., increased adherence and better self-care skills) that in turn affect the
health and well-being of the patient [4].
Identifying interventions capable of improving self-care and coordination with health
care providers for cancer patients is a topic of growing importance in that chronic dis-
eases, such as cancer, are a major reason for increased healthcare spending [5]. Among
chronic diseases, cancer is the second leading cause of mortality and was responsible
for 8.8 million deaths in 2015. Globally, nearly one in six deaths is due to cancer [6]. We
focus on lung cancer, which is the most common cancer worldwide, accounting for 1.8
million new cases and more than 1.6 million deaths per year – more than breast, colon
and prostate cancers combined [7].
Our goal was to develop an artifact that would reduce the amount of time a clinician
spends gathering routine data from patients at the beginning of each visit and, but also
simultaneously provide the clinicians with relevant and accurate information about the
patients. We investigate the use of mobile phones, one of the most accessible forms of
IT that has served as a platform for significant innovations that have impacted almost
all aspects of society. According to the Pew Research Centre’s 2017 report, more than
three-quarters of American adults (77%) now own a smartphone, but the fastest growing
demographic is people over 50, 74% of whom now own a device. In recent years, the

2 For details on the scoping review, please see http://hlwiki.slais.ubc.ca/index.php/Scoping_r

eviews.
 Delivering Effective Care Through Mobile Apps 5

emergence of mobile health apps in health care management has helped to overcome
geographical and organizational barriers to improve health care delivery [8]. In 2018,
approximately 50% of mobile phone users had at least one mobile health app on their
mobile phones [9].
Studies stress the importance of stakeholder input in mHealth application develop-
ment for them to reach their potential. Unfortunately, many mHealth apps are designed
without considering the needs of either patients or clinicians [10]. The literature lacks
empirically validated guidelines or process models on how to design apps with stake-
holders rather than for stakeholders [11]. We utilize a design science approach to develop
a mobile app for lung cancer patients that facilitates their interaction with their clini-
cians, manages and reports on their health status, and provides them access to medical
information/education. Our approach co-creates the IT artefact in collaboration with
cancer patients and clinicians, who are the two important stakeholders. Our four aims
are as follows: 1) identify what functionality is to be included in the mHealth app so
the app is valuable for healthcare processes (improving patient-clinician relationships
and the effectiveness of care delivery); 2) design an mHealth app that is valuable for
patients and clinicians and includes them at the center of the design process; 3) test,
redesign, and evaluate the validity of the mHealth app; and 4) identify generic design
guidelines that can be utilized for the creation of mHealth apps for the management of
chronic diseases. After completing the research process defined above, we conducted
a reflective examination of our findings and identified emergent themes that we fur-
ther developed into design guidelines. These design guidelines summarize what we
learned from the design-testing-redesign evaluation cycles of our artefact and represent
actionable knowledge that is grounded in evidence from the field.

2 Background

mHealth can be particularly important to cancer patients receiving treatments because

they experience one or more side effects that can have a profound effect on their quality
of life [12] and can also lead to dose delays, dose reductions, reductions in dose density
and, in some cases, dose discontinuation. This reduces the effectiveness of chemotherapy
and leads to worsening health for the patients [13]. Furthermore, these patients substan-
tially increase the utilization of healthcare resources through increased hospitalization,
emergency room visits, and the adoption of palliative treatments and ultimately increase
the care-giving burden, which results in increased costs for healthcare systems, patients
and care givers.
Mobile monitoring devices could allow patients who experience severe symptoms
to measure and record their health conditions and send the data electronically to physi-
cians or specialists without delay, which also empowers patients to increase their self-
confidence and self-management [14]. Currently, mHealth solutions are used for limited
purposes in cancer care, with a prevailing focus on treatment activities [15]. This under-
utilization may be due to several factors, including environmental, regulatory, techno-
logical, and organizational elements [14] or the distinctive characteristics of the target
populations (patients and clinicians). For example, consumers are concerned about the
use of their data when using mobile devices for health-related activities, which dilutes
6 M. C. Tremblay et al.

the potential to collect real-world data for research and development. Some medical doc-
tors fear that mHealth may jeopardize the patient-physician relationship and increase
their workload [16]. Providers are reluctant to adopt mHealth technologies unless these
services are adequately reimbursed [17]. Huckvale and Car also noted that apps are
normally designed without considering the needs of their users, including both patients
and clinicians [10]. In fact, despite the important role physicians play in the success of
mHealth initiatives, little empirical research has examined how physicians use mHealth
to manage patient health outcomes [18].

3 Design-Test-Re-Design: The Case of LuCApp

We designed, tested, redesigned and evaluated LuCApp, an mHealth app for lung cancer.
Our research process is described in Fig. 1.

Fig. 1. Research process

We distributed two surveys targeting two populations of mHealth application stake-

holders – randomly selected cancer clinicians and patients who use Internet-enabled
mobile devices, such as smartphones. The two survey instruments were developed after
consulting the literature and previous experiments on mHealth3 . The results from the
survey were shared with several stakeholder groups to solicit input and feedback. An
international workshop was organized in Milan on April 8, 2016, to facilitate interac-
tions with more than 100 stakeholders, including patients, clinicians, app developers,
the pharmaceutical and medical technology industries, telecom industries, experts in
medical communications and health education, payers and policymakers.
The feedback from the workshop was used to develop a set of questions that we posed
to an expert roundtable. The roundtable consisted of four participants who represented
3 The study survey is available upon request. Citation blinded for review.
 Delivering Effective Care Through Mobile Apps 7

two leading patients’ and clinicians’ associations based in Europe and the USA. The aim
was to gather more specific insights and suggestions about the design and development
of a lung cancer app. The discussion was moderated by a member of the research team.
The roundtable was recorded and later transcribed for analysis. The moderator utilized
probing questions to solicit suggestions from the participants concerning three main
themes: 1) information content, 2) interface design, and 3) usability. The roundtable
results were in turn used to create an interview script that was utilized to conduct five
in-depth interviews with oncologists from different Italian hospitals. The participants
included four oncologists that specialized in lung cancer and one clinician that spe-
cialized in cancer palliative care4 . Each interview lasted approximately 60 min, was
recorded and was analyzed by two independent coders using content analysis to identify
the main themes. The clinicians helped us identify a specific type of cancer patient who
could benefit from an mHealth app – patients diagnosed with small or non-small cell
lung cancer that were eligible for chemotherapy, immunotherapy or biological therapy
and the purpose of our mHealth application:

1) Improve the efficiency of the patient visit with real-time acquisition of critical data
that can be useful for the clinician during patient visits. The app helps to collect
and synthesize data for use by clinicians during a visit, which saves unnecessary
collection time during appointments.
2) Improve the patient’s quality of life (QoL) by helping to achieve better management
of side effects caused by cancer therapies.
3) Achieve earlier detection of any worsening of the disease by bridging the gap between
clinicians and outpatients.
4) Reassure patients by providing them with a means for supporting their continuity of
care (which is particularly important for fragile persons).

4 LuCApp Development
The app was developed by an IT firm in collaboration with the team of researchers
involved in this study. The preliminary version of the app was built for both the iOS
and Android platforms. The lung cancer application was designed and developed to
be used in Italy; thus, all of its features and functions are in Italian. Figure 2 shows
the main screen of the app. LuCApp also includes automatic alerts, reminders and tips
that complement the patient’s therapy. The app was developed to comply with EU pri-
vacy regulations and the General Data Protection Regulation (GDPR). In addition, the
development followed all of the guidelines from the Apple Store Review Guidelines
and Android Market Guidelines. There are two versions of the app, one for clinicians
and one for patients. After the feasibility assessment, the first prototype was released to
the research team for trial and feedback. The overall development effort, which lasted
eight months, was performed utilizing DevOps methods [19] to provide the following
for all nine releases in parallel: integration with the validated platform, full execution
of the full test suite, quality control (according to European regulatory standards), and
4 Palliative care is any treatment that focusses on reducing symptoms, improving quality of life,
and supporting patients and their families.
8 M. C. Tremblay et al.

release reliability. By leveraging DevOps approaches, the team of researchers obtained

rapid feedback throughout the development, test, and implementation processes, allow-
ing them to evaluate all proposed improvements iteratively. In turn, the research team
contributed feedback, thereby accelerating the review process in both the Apple and
Android stores.

Fig. 2. Screenshot of LuCApp.

5 LuCApp Test and Redesign Using the Exploratory Focus Group

After careful consideration of several possible techniques that would allow us to test,
redesign and evaluate [20] our LuCApp, we decided to use focus groups that consist of
oncologists and patients [21]. The focus groups allowed us to probe them on key ideas
– specifically, on the functionality and usefulness of the app. Furthermore, the interaction
between the respondents allows for key insights that normally do not surface with other
techniques. Tremblay, Hevner [21] described two types of focus groups: exploratory
focus groups (EFGs) for the design and improvement of an artefact and confirmatory
focus groups (CFGs) for evaluating the application in the field. We used the EFGs to
provide feedback for the improvement of the design of the lung cancer application. In
the second phase, no additional changes were made to the lung cancer application, and
the CFGs were used to evaluate the app for usability and usefulness.
For the EFGs (as well as for the CFGs), the planning process included creating a
carefully planned script. The main topics of both EFGs included understanding i) how
using a mobile health app as part of the routine practice of managing cancer patients could
affect how clinicians monitor and evaluate patient health outcomes and their decision-
making process and ii) how the app could affect patient quality of life and the quality
of services offered by healthcare institutions. Before each focus group, the moderators
introduced the project, explained the objectives and provided general information about
 Delivering Effective Care Through Mobile Apps 9

the focus group. Furthermore, possible improvements to the app were agreed upon,
which was aimed at refining the app before the final release.
Specifically, sample screenshots were used to gather users’ feedback on the overall
usability (e.g., layout, font size, and color) and attractiveness of the functions (e.g.,
content and design). The focus group script was divided into several parts reflecting the
main operational implications from a clinician’s perspective (the script is in Italian and is
available upon request). The focus groups (both the EFGs and the CFGs) were recorded
and professionally transcribed. The transcripts were analyzed using computer-assisted
qualitative data analysis software (CAQDAS). After the initial coding had highlighted
relevant discussion themes, all of the text segments were iteratively analyzed. Themes
were added or merged until they effectively represented all of the text segments and
captured the essence of the discussion. The coding frame was refined with discussions
about areas of disagreement and consensus, and any differences in interpretation were
reconciled by the authors (the inter-rater reliabilities were 78% for EFG1, 76% for
EFG2).

5.1 Feedback from Clinician Exploratory Focus Groups (EFG1 and EFG2)
The clinicians in both EFGs agreed that LuCApp could improve their ability to evaluate
the patient’s condition. Most of the focus group participants made similar comments
and discussed several instances in which this app would be useful in their daily activ-
ities. The clinicians particularly appreciated the possibility of being informed in real
time by patients about their symptoms and about the severity of their symptoms; this
timeliness would allow them to quickly contact the patients and make suggestions for
next steps. Furthermore, clinicians found the “trend” component of the app of major
importance. One doctor focused on how the use of the app could change current stan-
dards, highlighting that instead of using email and WhatsApp, this approach could be a
more systematic, innovative and effective solution. However, one clinician in the second
focus group noted that the effectiveness of the solution could depend upon the stage of
the disease and the type of cancer; patients often have serious symptoms, and as they
become worse, it would be difficult for them to use LuCApp by themselves.
The findings from the clinicians can be summarized in two categories: functionality
and usefulness. In terms of functionality, it was clear that the navigation and structure
of the app must be evident for both patients and clinicians. Regarding the usefulness
of the app, physicians want the ability to evaluate patient progress and monitor patient
symptoms; they felt that they could improve the patient’s quality of life if the app provided
mechanisms to reassure the patient. It is also important to them that the app integrate
all necessary clinical information. Finally, the physicians want the app to give them the
ability to continuously evaluate patient progress and monitor patient symptoms.

5.2 Feedback from Patient Exploratory Focus Groups (EFG3)

The patients stated that LuCApp reminded them of a powerful diary that they could fill
in every day and share in real time with clinicians. The clinicians could then access the
patient’s information and be in contact with the patient when necessary. The patients also
emphasized the relevance of symptom monitoring. This functionality would provide a
10 M. C. Tremblay et al.

mechanism to collect data that could be used to improve therapeutic treatment plans,
not only for themselves but also for other patients now and in the future. The patients
noted that LuCApp would make them feel safer. By using LuCApp, they would be able
to communicate their symptoms in real time in cases when the symptoms were mild,
moderate, severe or extreme. This ability is particularly important when patients have
mild and moderate symptoms that could be serious but are not usually communicated to
the clinician. The participants stated that this reporting could also help advance science;
clinicians could learn what mild and moderate symptoms could lead to adverse outcomes.
An important emergent theme is how LuCApp could influence the patient’s relation-
ship with caregivers. Stressing the importance of keeping their caregivers in the loop,
some participants suggested that it could be useful to create a login and password to
LuCApp for them to access important information about the patient’s care. This ability
would be helpful in reassuring the caregivers, particularly when the it is a spouse or
son/daughter. The participants indicated that LuCApp would improve their relationship
with the clinicians because the clinicians would be able to access all of the data and
information in real time. The participants were aware that the app would not substitute
for real contact with the clinicians during regular checks but felt that LuCApp would
keep the clinician better informed and updated about what is happening with the patient.
We considered this initial feedback about the app from the patient EFG and partic-
ularly what this might mean for our design guidelines. Regarding the functionality and
usefulness of the app, we learned from the patients that: 1) the navigation and structure
must be clear; 2) the app must use fonts and colors that are appealing to patients; 3)
patient quality of life can be improved if the app provides mechanisms to reassure the
patient; and 4) the app must facilitate communication between clinician and patients.

5.3 Redesign of LuCApp

The comments on user needs and preferences and app functionality and usefulness
from all three exploratory focus groups were classified using the following themes:
content and information (e.g., features, functions and relevant symptoms), navigation
and structure, and design and presentation (e.g., use of color, graphics, and amount
of text). The considerations for selecting which modifications to apply included the
number of participants who mentioned the app, the context of use, overlap/integration
with existing information and technical feasibility.

6 LuCApp Evaluation Using Confirmatory Focus Groups

The same panel of clinicians was included in the two clinician EFGs. However, a new
panel of patients was involved in CFG3. Like the EFGs, the CFGs were recorded and
professionally transcribed (the inter-rater reliabilities were 79% for CFG2 and 77% for
CFG3). We applied the same demo approach described for the EFGs; illustrating the
revised version of the mobile app based on the comments and suggestions received in
the EFGs. The participants were presented with a new list of symptom definitions. The
list that was previously presented during the EFGs was revised and simplified using less
medical jargon, a suggestion made by the clinicians during the EFGs to make the list
 Delivering Effective Care Through Mobile Apps 11

less difficult for patients to understand. The clinicians (who had also participated in the
EFGs) said the new labels were very clear. Moreover, the patients agreed even though
they did not consider this issue to be a major one to be fixed because they considered
themselves familiar with medical wording, and the issue was part of a single case; they
did not request a specific modification to simplify the wording. The clinicians in EFG2
had suggested the elimination of graphs and trends because they were worried that they
would unnecessarily scare the patient (e.g., if they saw that they vomited three times
in one week). When we raised the issue to a different panel of clinicians (CFG1), they
initially did not understand why the change was necessary, but after explaining the
reasons, they eventually agreed that showing patients this type of information was of
little use and could have a negative effect on their quality of life.
Conversely, EFG3 (patients) was enthusiastic about the trends section, finding it one
of the most useful functions. When we presented this functionality to CFG3 (patients),
we asked them to decide whether to keep the trends functionality or to remove it. We
explained that the clinicians were worried that this information could scare or stress
them. The patients did not agree with the clinicians and were in complete concordance
with the patient EFG. They felt that the trend section was one of the most important
and relevant features. The research team decided to keep this functionality in the latest
version of LuCApp. Based on results from this phase, we conclude that the app was well
received by the users.

7 Design Guidelines
We derived three categories of design guidelines based on a reflexive examination of
the themes that emerged from the survey, workshop, roundtable, expert interviews and
focus groups: design process, functionality and usefulness.
Our process design guidelines indicate the fundamental role of stakeholders in the
development of the app. Our two functionality design guidelines are related to the usabil-
ity and attractiveness of an mHealth application. Three usefulness design guidelines indi-
cate the functionality necessary in the mHealth application to achieve our goal – better
coordination in the management of chronic disease.
Design Process
DG1: Stakeholder involvement. Stakeholders must be involved not only in the require-
ment gathering stage but also throughout the entire iterative design process. Direct and
active interaction and cooperation between users and developers of the app enhances
the quality, functionality, usability, design and utility. Different stakeholders might per-
ceive information elements differently; thus, including different viewpoints improves
the design. The intentional inclusion of difficult-to-serve clients, such as severely ill
patients may be the best way to improve the final artifact that will serve all types of
customers better. While traditional approaches stress standardization typically from the
perspective of the practitioner, our focus group interviews suggest that this orientation
may result in designers excluding aspects or features that create the most value.
Functionality of mHealth App
DG2: Navigation and structure must be clear for both patients and clinicians. The typ-
ical lung cancer patient is elderly and needs an app that is easy to navigate through the
12 M. C. Tremblay et al.

different sections and screens (i.e., scroll systems should be used). Conversely, clini-
cians do not want to spend too much time searching for information. Ease capturing of
information (e.g., dropdown boxes) is important to minimize effort of use.
DG3: Presentation must use fonts and colors that are appealing to patients. The typical
lung cancer patient is elderly; thus, the font size and spacing of text should ensure good
readability, the text for labels and buttons should be clear and concise, and the colors
should provide good readability and good contrast.
Usefulness of mHealth apps
DG4: Ability to evaluate patient progress and monitor patient symptoms. Symptom
descriptions should be simple and clear. Symptoms list should be accurate, complete
and disease-specific. Functionality should include the ability to monitor and assess side
effects caused by cancer therapies.
DG5: Improve patient quality of life by providing mechanisms to reassure the patient.
Provide the possibility of sharing patient’s symptoms and side effects with clinicians
in order to receive rapid feedback about what to do and facilitate earlier detection of
worsening disease.
DG6: Integration of all clinical information. Provide the ability to port data directly into
other systems and platforms they use.
DG 7: Ease of communication between clinician and patients, including the ability for
the clinician to view patient history.

8 Contributions
In this study, we introduce a mixed-methods design process based on a combination of
quantitative, qualitative, exploratory and evaluation activities, such as a survey, work-
shops, interviews, and focus groups. This approach allowed us to obtain nuanced under-
standings of both the clinicians’ and patients’ needs and of the challenges and intricacies
of chronic disease management of a particularly complex chronic disease, lung cancer.
Lung cancer patients tend to be elderly and have a high symptom burden, and the disease
has both difficult and painful physiological and major psychological effects.
As a team, we reflected that without following the design-test-redesign design sci-
ence approach highlighted in the paper, we likely would have developed a completely
different app. The direct and active interaction and cooperation between the users and
developers of the app enhanced its quality, functionality, usability, design and utility,
as was emphasized during the interviews and the focus groups we conducted with the
clinicians. The overall process of our research highlighted how a design science app-
roach can be used to build useful mHealth applications using approaches that bolster user
acceptance. We proposed a series of design guidelines that highlight the overall implica-
tions and contributions of this work. Our guidelines (or technological rules) were built
as a reflective cycle [22]. We chose the case management of a chronic disease, specifi-
cally, cancer. Our design guidelines were a result of the research team reflecting on our
journey and can be categorized as design knowledge that can be tested and refined in
subsequent cases in other chronic disease management contexts and/or be directly used
by practitioners [22].
 Delivering Effective Care Through Mobile Apps 13

We observed the transformative capacity of an IT intervention, LuCApp, on severely

ill lung cancer patients. The information gleaned from focus group interviews allowed
us to take a step toward opening up the black box of efficacious treatment for severely
ill cancer patients. From the patient focus groups we learned how accounting for the
perspective of extreme customers in the technology design phase may could enable
designing an mHealth app that serve all types of customers better. Often the most vul-
nerable consumers are the least involved, which exacerbates the inequalities of care [23].
In our study, we focused on extreme cases of customers – lung cancer patients, many of
whom were in their final stages of life – and found that these individuals were optimistic
about the potential impacts of the mHealth app we designed with their input.
We acknowledge that in a perfect world, we would have had the opportunity to
test the app live and collect feedback from a large number of users. However, we must
reconcile this ideal with the realities of the world in which we live. The developed
app was tested in a smaller group due to resource constraints. In addition, we believe
that although the collected feedback might not be representative of every opinion of a
potential user, is rich and informative. Another limitation of our study is that it was solely
conducted in one country, Italy, which might hinder the generalizability of our results.
Cultural beliefs and values might influence the opinions of both health professionals
and patients. Therefore, further research is needed to investigate the validity of our work
across different jurisdictions.

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native style as our lack of physical training would permit, upon the
cushions transferred to the floor. In this way when our callers, who
included such truly gentle men and ladies as the Mayor of the city
and his wife, the steward of the Count, the daughter of an ex-Mayor
of Osaka, Baron Kimata, the venerable Doctor Nakashima, for thirty
years a pillar of the church and a prosperous physician, Mr.
Kitamura, whose father was a retainer and served as secretary of
the Baroness Ii, and others, came in, knelt upon the floor and
touched their heads three times to the mats, we, too, could return
their salutations with the same delightfully elaborate but now rapidly
vanishing attention to the etiquette of playing host and guest.
The reception over, with its accompaniment of tea served in
ceremonial cups, we were urged, in spite of our protest that we had
had dinner upon the train, to a bountiful feast. This, too, was of a
mixed character; part of it taken from two large hampers of foreign
food sent on from our hotel in Kyoto, and part of it fish from the lake,
cooked a la Japonaise and served on pretty shell-shaped plates, rice
in covered bowls manufactured in Hikoné in the days of the great
Baron, and other native viands, made more tempting by the
harmonious suggestions of the dishes in which they were served.
Such delicate pleasures of suggestion, also, belong to the art of
living as practiced in feudal Japan. And when, notwithstanding
remonstrance, the dishes themselves were divided between guests
and hosts,—the portion of the latter to be retained, it was explained,
as “memorabilia of the honour of being permitted to serve, etc.,”—
this, too, was quite in the spirit of the time when Ii Kamon-no-Kami
was lord of Hikoné.
After the supper we were led to the large audience-hall of the former
villa, where all the shoji were plain gold-leaf and the ceilings chastely
but beautifully panelled; here we were fairly compelled to sit in the
throne-like chairs on the raised alcove, which was in feudal times
reserved exclusively for the lord of the clan. The cold made the
combined efforts at heating of a modern oil-stove at the back, with
antique hibachi on either hand, by no means ungrateful. Beside each
of the guests knelt an interpreter, who was to announce the different
numbers and translate their comments on the music; while all the
hosts sat ranged along the other side of the hall, native fashion on
the floor. Thus a somewhat weird but vivid and interesting picture,
reminiscent of the older times, was made by this large and dimly
lighted baronial hall, in which the lord of Hikoné may well enough
himself have listened to some of the same music which was played
for us. The first number on the programme proved to be a selection
of the oldest style of Japanese concerted music; it was played on
three different kinds of flute by three young men, all dressed in dark
silk kimonos and in head-dress of two hundred years ago. Then two
pretty girls, beautifully gowned and with faces powdered and lips
tinted vermillion and gold,—the ancient manner of decoration in such
cases,—together with their teachers, played a Spring “nocturne” on
three Kotos, or Japanese harps. Other selections followed; and the
concert closed with a queer fugue-like performance on Chinese
flutes—one short and the other a full yard long, but both gaily
decorated with silken cords and tassels.
The evening’s entertainment over, we returned to our room, which
had now been converted into a bed-chamber in truly royal native
style. Six large wadded futons, three to lie upon and three for
covering, all made of fine silk, had been laid upon the floor, with
quilts rolled up and tied together for pillows, and lead tanks covered
with a soft flannel and filled with hot water to secure additional
warmth. For the thin wooden shutters which enclosed the piazza and
the paper shoji within, however closely drawn, could not serve
efficiently to keep out the cold, snow-laden wind. It was part of the
stately fashion with which everything was conducted, to assure us
that all the bedding was quite new and had never been used before.
 “ALL COVERED WITH FRESH FALLEN SNOW”
In the morning, when the room had been again prepared for its day-
time uses, the beauty of its screens and other simple furnishings,
painted in raised chrysanthemums by one of the Kano school, was
made the more charming by the light reflected from the snow-
covered ground and cloudy sky. The garden was a picture such as
can be seen only in Japan; its tiny curved stone-bridge over an
artificial pond, the dark green twisted pines, the stately mountains in
the distance; and all covered with fresh-fallen snow—a landscape
made dignified by nature and exquisite by man.
The later morning hours were occupied with receiving calls, each
one of which bore some fragrance of the memory of the man who
had, as the sons and daughters of his retainers firmly believed,
sacrificed his life in the country’s cause. For still in Hikoné, the
memory of Ii Kamon-no-Kami, and the pride in him, confer a certain
title to distinction upon every citizen of the place. And not only this;
but we, being Americans and so of the people with whose
representative their feudal lord had joined himself to bring about a
period of peaceful and friendly intercourse between the two nations,
were expected to sympathise with them in this feeling. In genuine
old-fashioned style, many of these visitors brought with them some
gift. Among these gifts was a small bit of dainty handiwork, made by
the Baroness Ii and given to the father of the man who gave it to us,
in recognition of his services as her secretary. It was the sincerity
and simple dignity of these tokens of friendship which raised their
bestowal above all suspicion of sinister motive, and made it easier
for the foreigners to receive them and to transport themselves into
the atmosphere of the “Old Japan.”
The afternoon of this day was set aside for the lecture, which was to
be held in the large room of one of the city’s Primary-School
buildings. On reaching the school we found the flags of both
countries—the two that Ii Kamon-no-Kami and Townsend Harris had
bound together by Treaty, a half-century ago—hung over the door,
and at the back of the platform on which the speaker was to stand.
But before he could begin, the guests must be presented to yet other
of their hosts, who also came to leave in their hands testimonials of
their pride in Ii Kamon-no-Kami and of the good-will of Hikoné to the
visitors from the United States.
One will not easily find elsewhere a more intelligent and serious
audience than the 500 who sat upon the floor of the school-room in
the castle-town of the patriot Naosuké, on the afternoon of February
3, 1907. One will probably not find at all, outside of Japan, in a place
of the same size, so many persons to listen so patiently to so long a
discourse on similar themes. For the talk in English and its
interpretation into Japanese required more than two solid hours. Nor
could this time, of itself, suffice. There must also be elaborate thanks
returned by the steward of the present Count, in the city’s name; and
to the thanks a reply by the lecturer, both extended to a proper
length. For such deliberateness in doing what it is thought worth
while to do at all, is also characteristic of the time when Ii Kamon-no-
Kami or the other Japanese Barons discussed with Townsend Harris
every point of the Treaty, during the months so trying to the patience
and ingenuity of both parties.
The lecture over, and greetings and leave-takings exchanged, the
foreign guests were escorted to the station by a long row of following
jinrikishas. In the private room of the station-master the time of
waiting was spent in anecdotes and stories reminiscent of that
disturbed and critical but glorious past. The chief of police who had
been attendant, in order to give dignity to the occasion and to secure
the visitors from the least shadow of annoyance—danger there was
none—now comes forward to be presented and be thanked. Tea and
cakes are served; and these are followed by renewed expressions of
gratitude and friendship. In spite of remonstrance, the sweet-faced
old doctor and the Christian pastor are instructed to accompany us
all the way back to our hotel in Kyoto. And when, after renewed
expressions of esteem for Ii Kamon-no-Kami and of the friendship for
us and for our country, we send our escort back to Hikoné by the
midnight train, we certainly—and I trust—they also, had pleasant and
permanent memories established, connected with the beautiful
castle-town on Lake Biwa and its now honoured, old-time feudal lord.
And I, for my part, had certain impressions confirmed by this
interesting visit to the home of the famous lord of Hikoné. It is in the
country places of Japan, and especially in its old feudal towns, that
the choicest products of its characteristic civilisation are, at present,
to be found. Here the virtues of chivalry chiefly linger; here these
virtues are being combined with the intelligent outlook over the world
imparted by modern education and with some of the virtues which
are in particular fostered by the faith of Christianity. The result is a
charming type of manhood and womanhood which the Western
World may well admire, and, in some respects, emulate. It is this
spirit of chivalry which has carried the nation along its wonderful
career down to the present time. And it is the hope of the thoughtful
Japanese, as well as of their sympathising foreign friends, that this
spirit will not be quenched by the inpouring of the commercial spirit
of the modern age.
Again also, it was impressed upon my mind that no other of the
formerly “hermit nations” has hitherto incurred such grave risks in
yielding to Western forces for its so-called “opening,” as did Japan in
the years from 1853 to 1868. But then, no other nation has reaped
such benefits from the yielding. For Japan was opened—the great
majority of its leaders and people being reluctant and hostile—by the
display of a superior force of Western armament and at the risk of
having the national life deluged, if not extinguished, in blood. Yet the
heart of the nation has learned to respond with gratitude to those
who brought about such a turning of the door which had hitherto
been closed to the world, upon the hinges of destiny. “Commodore
Perry,” said Count Okuma to the writer some years ago, “was the
best friend Japan ever had.” With the name of the Commodore we
may fitly couple that of the Consul-General, Townsend Harris; and
we may not unfitly add that one of the best foreign friends which the
United States ever had was the Japanese Tairō, Baron Ii Kamon-no-
Kami. When we remember what risks his nation ran, under his
leadership, in order to solve peacefully the vexed question of foreign
trade and foreign residence, may we not also remind ourselves of
the propriety that somewhat more of the same spirit of chivalry
should govern our conduct in dealing with the same question, now
that a half-century of continued friendship has bound together the
two nations, whose representatives—the one so patiently, the other
so bravely—solved it in that older time of agitation and threatened
disaster?
 CHAPTER XI
HIRO-MURA, THE HOME OF “A LIVING GOD”

Among the more startling but characteristic of the sketches of “Old

Japan,” as drawn by the skilful pen of Lafcadio Hearn, there is
perhaps no one which has excited a wider interest than that he was
pleased to entitle “A Living God.” The few pages which it covers
illustrate all the well-known excellencies and faults of this gifted
writer. Purporting to give facts, but quite careless as to what the facts
really were, exaggerating impressions and twisting the meanings of
quaint old-time customs and faiths, Mr. Hearn nevertheless
celebrates the deed of Hamaguchi so as to initiate the reader duly
into the spirit of a half-century ago, in the Land of the Rising Sun. I
say, “a half-century ago”; for although the story makes its hero to
have died at an advanced age more than a hundred years before,
the real Mr. Hamaguchi died in New York City, as late as April 21,
1889, at the age of sixty-six. He was then only thirty-two years old
when in 1855 he enabled the villagers of Hiro-mura to escape with
their lives from the overwhelming wave caused by the earthquake of
that year.
It is worth while to correct some of the other mistakes of Mr. Hearn,
before giving the narrative of a recent visit to Hiro-mura, where we
were the guests of the present head of the Hamaguchi family. These
mistakes, indeed, do not at all detract from the nobility of the hero’s
action, nor greatly mar the writer’s reputation for picturing graphically
a certain aspect of the spiritual life and character of the Japanese.
Since it does not appear that he had ever travelled in this part of the
country (we were assured by our host that we were the only
foreigners who had ever been seen in Hiro-mura), the topical
inaccuracies of Mr. Hearn’s story are easily excusable. Instead of
Hamaguchi’s watching the merrymakers of the village from a farm-
house on the hill-side, he saw the ebbing of the water that followed
the earthquake and presaged the incoming wave, from his own
house which was in the village itself. Indeed the heighth to which the
water rose in its rooms was pointed out to us as it was marked
plainly upon the wooden pillars in front of the tokonoma, or alcove
where the artistic and other similar interests of a Japanese
household are centred. Nor was the man himself simply the principal
farmer of the district. For many generations his family had been one
of the largest and richest in this part of Japan. Their wealth had been
accumulated in the manufacture of Shoyu—the Japanese sauce
invented as a modification of a Chinese original, which was
introduced into Japan some centuries ago by a Buddhist priest, and
without which no food “tastes good” to the modern Japanese.
Moreover, the huge wave occurred in the middle of a moonless
night; and thus the stacks of grain, which were not only his own, but
also all that Hamaguchi could come upon in the village, served for
lights to guide the villagers in their flight; and not at all, as Mr. Hearn
would have us believe, for signals that their help was needed to
rescue a neighbour’s property from fire.
Mr. Hamaguchi did, however, come perilously near to losing his own
life for the sake of saving the lives of others; for he was himself the
last to leave the lower ground of the village and escape to the hills.
As it was, he was saved only by making a marvellous jump across a
stream which checked the relentless wave that was pursuing and
overtaking him. His son, Mr. Tan Hamaguchi, tells us this incident,
which is unmentioned by Mr. Hearn, and adds: “I can recollect well
that in my boyhood I used to bathe and fish in this very stream,
without realising that it had been the means of saving my father’s
life.” Nor is it true that the hero “continued to live in his old thatched
house on the hill, with his children and his children’s children, just as
humanly and simply as before, while his soul was being worshipped
in the shrine below.” Even before the incident narrated above, at the
time of the coming of the “black ships”—i. e., Commodore Perry’s
fleet,—Hamaguchi Gōryo had been prominent in politics as one
opposed to admitting foreigners without armed resistance; and, after
their admittance, he organised the militia of his Province and drilled
them according to his ideas of the European system. At the time that
the supreme power was restored by the Revolution to the Emperor,
Gōryo was appointed to a position corresponding to that of
Postmaster-General. And later, in 1879, when the Ken-Kwai, or
system of a local body of representatives, was introduced, he was
elected president of the Council of his native place. Still later he
organised a so-called “conciliation society,” which, while deprecating
the then rising, ignorant strife of the political parties in process of
formation, urged a “careful study of politics, rather than unrestrained
violence and empty vapourings of irresponsible talk.” Like other
notable Japanese of his day, Hamaguchi had for years previous to
his death cherished the plan of foreign travel for the purpose of
studying the social and political institutions of foreign countries.
Indeed, it was in pursuance of this plan that—as has already been
said—we find him in New York City, where he died in 1889.
But this true patriot did not forget his own humble village in his larger
interest in the political development of the province of Kishu and of
the country at large. The tidal wave of 1885 had left nearly the entire
village of Hiro-mura desolate, and its inhabitants homeless, destitute,
and quite unable to provide for themselves. Hamaguchi Gōryo found
employment for them by organising and carrying through a scheme
for building an enormous dyke to protect the village from future
inundations. This dyke, now shadowed with well-grown trees, under
which we took a part of our Sunday’s walk, March 10, 1907, is 1800
yards in length, 16 yards wide, and 5 yards high. “With the
permission of the Daimyo of Kishu” (how thoroughly of the “Old
Japan” does this phrase smack!), and with the assistance of his
kinsman, Mr. K. Hamaguchi, the whole cost of this expensive
construction was defrayed by their private means. Moreover, Gōryo
did much for the roads and bridges, as well as the farms, of this
region in Kishu.
But quite apart from any curiosity to see the village where dwelt the
hero who won by his courage and benevolence the name of
Daimyojin, or the “divinely great and bright” (it is not true, as Lafcadio
Hearn affirms in his semi-fairy tale, that a shrine was built to Gōryo
during his life-time by the villagers), I had other important reasons for
visiting Hiro-mura. A former pupil of mine, Mr. Takarayama, was
principal of a flourishing school which has been established and
patronised generously by the Hamaguchi family. An invitation from
the head-master and the patrons of this school, and their
representations as to what it would mean for the cause of education
in the whole district, combined with descriptions of the beauty of its
scenery and the as yet unsophisticated nature of the country people,
were quite sufficient to make us eager to be the first of foreigners to
see and describe this wholly unfamiliar part of Japan. In all these
respects, as well as others, our experiences left us emphatic in the
conclusion that we had seldom, or never, in any part of the world had
a more rewarding three days of travel and of sight-seeing than those
spent in this trip through Kishu.
In order that we might reach our destination by a single day’s travel
in jinrikishas—for the village is some twenty-five miles from the
nearest railway station—we went from Kyoto to Osaka on the
evening of the day before and took the early morning train for the
interesting and beautiful town of Wakayama. At the station in Osaka
we found the reserved carriage which the Governor of Wakayama
had requested to have ready for us. As the manager of the railway
acknowledged “the honour which we were doing his road by
condescending to travel over it,” I think we felt somewhat as the
daimyo of Kishu must have felt when he granted “permission” to
Hamaguchi Gōryo to pay for the dyke which the latter’s enterprise
and industry had succeeded in building.
The ride between the great manufacturing and modernised city and
the ancient town, with its well-preserved feudal castle, is entertaining
throughout; the part along the sea is especially picturesque. On the
platform of the station at Wakayama stood the Mayor, the heads of
various educational associations, and others, ready to welcome the
arriving guests in the customary formal but friendly fashion of “Old
Japan,”—adapted, however, to modern conditions of travel and
clothing. Four jinrikishas, with three runners for each, were in
waiting. After a short interval of discussion as to certain details, all
were arranged in proper order;—our escort from the city leading the
way, then the lady and the gentleman who were guests (a reversal of
the ancient order of the precedence of the sexes), with Mr.
Takarayama bringing up the rear. The cavalcade started off at a brisk
trot which was broken only once during the first six miles; and this
was in order to pass a loaded cart where the road along the cliff was
somewhat narrow and rough. In this way we reached the village of
Kuroé in time for luncheon. A turn aside from the main street, a
somewhat steep climb by a branch road and then by a path through
the fields to the hill-side above the village, brought us to the beautiful
home of our mid-day host.
Mr. Kimura, who entertained us at luncheon that day, is a younger
brother of Mr. K. Hamaguchi, who, as so often happens in Japan,
has been adopted into another family and in this manner changed
his family name. Over the gateway to his private grounds were hung
the flags of Japan and of the United States; and the family, which still
retains something of its patriarchal constitution in the country places
of Japan, including a number of the principal servants, were all in
waiting to welcome the foreign guests. Mr. Kimura’s residence is
charmingly situated; the house, which is purely Japanese, although a
part of the structure is more than two hundred years old, is still in
excellent repair; in sunny and fairly warm weather it has the beauty
which is peculiar to the best Japanese dwellings when set in one of
those picturesque landscapes that abound here as nowhere else. In
the room where we were received were a few treasures of art, which
had been brought from the go-down for the occasion, such as a
princess might covet; some rare old kakemonos, a piece or two of
the finest lacquer, and one of the most interesting and artistic of
bronze vases for flowers which I have ever seen. The base of this
vase represented, or rather suggested in barest outline, the surf of
the sea, with sea-birds flying here and there above the curling
waves.
This entire district is an interesting example of the persistence in
modern times of artisan and artist work, as done in humble houses
by private individuals and families, with a certain independence and
pride of craft, and on their own account as it were. In and about this
small and obscure village of Kuroé there are as many as one
thousand houses in which work in lacquer is going on. Most of this
work is, of course, of cheap and ordinary character; although some
of the older forms of cheap utensils of lacquer have a certain artistic
beauty. Other specimens of the work done to-day in these houses of
the village and the adjoining fields may, however, well lay claim to a
rather high order of merit. For if there is not much initiative or
originality shown by the peasant workers, the designs of the
celebrated Korin, made a century and a half ago, are still being
faithfully and skilfully copied by them. But there surely was not much
work done, whether in fields, shops, or houses, during the hours of
our stay. For the people, of all sorts, ages, and sizes, were gathered
in groups, with that mild-mannered and unabashed curiosity which
characterises the old-fashioned country folk of Japan, to watch the
doings of the strangers who had so suddenly and unexpectedly
appeared within their borders.
If further experience had been needed—as, indeed it was not—to
convince me of the ease with which one, properly introduced and
conducted, can make acquaintances among the good people of
Japan, our short stay with Mr. Kimura and his family would furnish it.
We met at noon as strangers; we parted at two in the afternoon of
the same day as friends. As a souvenir of this friendship both host
and guests cherish a photograph in which four generations of this
Japanese family, and its trusted and aged head-steward, are
grouped around the foreign visitors.
From the village of Kuroé to Hiro-mura the jinrikisha ride is one of
almost unexampled charm. Indeed the landscapes through which we
were passing combined the three qualities of such charm—beauty of
form, beauty of colour, and human interest—in a higher degree, I
think, than does either the drive around the Bay of Naples or along
the Bosphorus. The day was superb—bright with the light of the sky
and the sparkling of the sea, and just cool enough for comfortable
travelling. We had changed runners and vehicles at Kuroé and so
our men were fresh and ambitious to show how well they could do.
The first part of the course took us over the tops and along the sides
of the cliffs above the Bay of Shimidzu, or “Clear Water.” Here the
landscape had its beauty of form contributed by the very
configuration of the coast-line and, as well, of the mountain’s slopes
and crests. But the curious and graceful curves of the terraces, both
above and below the road as it wound along the bay, and up and
down, were added features of delight to the eye that appreciates this
kind of beauty. The reddish brown of the rock, where it shone
through the sombre green of the lichens, emphasised by the light
green and fawn colour of the dried grasses, or the dark and almost
blackish green of the pines; the reaches up Between the cliffs, with
the variegated colours of the vegetable gardens, the ooze of the as
yet unplanted rice-fields, the shiny foliage of the orange groves, with
the various shades of yellow fruit showing in places through the
leaves; the limpid blue waters of the Inland Sea and of the Italian
sky, which combined to reveal all the many hues of shell, and
pebble, and seaweed, and reflected rock and tree and shrub,—all
this made an unsurpassed beauty of colouring to give warmth and
feeling to the beauty of form.

“PEASANTS
WERE GOING TO
AND FROM THEIR
WORK”
And then there was that indescribable picturesqueness of human
interest which belongs to the country places where most of the life of
“The Old Japan” is lingering still. In the succession of villages
through which we were passing, the houses, boats, costumes,
means of carriage, forms of labour, and modes of social intercourse,
were little changed from one and two centuries ago. The highway
was by no means solitary at any point of the twenty-five miles
between Wakayama and Hiro-mura. Indeed the absence of steam-
cars and of trolley made all the more necessary an active life on the
road in order to do the necessary business for this busy and not
unprosperous district. All along its course men were trudging with
baskets and buckets and immense packages slung on poles over
their shoulders. Peasants were going to and from their work in the
fields with old-fashioned mattocks and rakes in hand or over the
shoulder. Men and boys were pushing up, or holding back, along all
the slopes of the hills, the long dray-like carts, loaded with boxes of
oranges, or with bales of raw cotton to be spun, or of cotton yarn or
cotton cloth already prepared for the market. For just as a thousand
houses in the district nearer Wakayama are making things of
lacquer, so a thousand houses in this district are spinning cotton
yarn or weaving cotton cloth. We can hear the cheerful rattle of the
looms as we approach the way-side cottages—a noise which is
suspended as the cavalcade of curiously loaded jinrikishas draws
near; only to be resumed again when the workers have seen the
foreigners pass by. Indeed, a considerable percentage of the
products of the Fuji Cotton-Spinning Company, of which our host at
Hiro-mura is the president, is manufactured in the homes of the
villagers and farmers of this district. May a kindly Providence prevent
this sort of domestic industry from being displaced by smoky mills, in
crowded centres, under conspiracies of monopolies and trusts!
But bye and bye we leave the cliffs along the shore of Shimidzu Bay
and come to the Arida River. Here the scenery is still interesting and
beautiful, but of quite different character. Our road lies, much of the
way, along the dykes built to restrain the overflow of this stream,
down which, at the present time, an almost unbroken succession of
rafts of lumber is being driven by the lumbermen. Upon the banks of
the river is an equally endless succession of orange groves; for we
are now in the Florida of Japan. With as much propriety, we might
call it, so far as orange culture goes, the California of Japan. In these
groves, or rather yards,—since the fruit seems to be for the most
part cultivated in small patches in the gardens of the cottagers,—are
grown the small free-skinned and deliciously sweet oranges for
which this region of Kishu is particularly celebrated. But here, too are
the groves of Navel oranges, the trees for planting which were
imported from California some eight or ten years ago. (I noticed,
however, that this variety is deteriorating in Japan. The one small
hard semblance of an orange which is at the navel of the California
variety in this country, seems there to be multiplying itself three- and
four-fold, until it threatens to occupy most of the inside of what from
the outside appears to be a fine, large specimen of fruit.)
The quieter rural beauty, with its commerce along the river rather
than along the shores of the sea, is satisfying enough, however, to
prevent the fatigue of travel until we reach Yuasa, a village
separated only by about one mile from Hiro-mura. At the outskirts of
this place it is necessary to pass under an arch of “Welcome” which
the townspeople have erected; and then between lines of school
children, who, drawn up on either side to the number of three
hundred, greet us with bows and waving of flags. A little further on,
we are handed a large card which announces that twenty-five of the
chief men of the village of Yuasa have also come out to welcome us.
And there they are—friendly and yet dignified in their bearing—in a
single row along one side of the highway. Evidently the demands of
politeness cannot be satisfied in such a case by allowing one’s self
to be drawn in one’s jinrikisha slowly by the line, with uncovered
head and frequent exchange of bows. So the male of the two guests
dismounts and on the common level of the highway exchanges
salutations with the numerous representatives of the party of the
host.
While passing through the streets of Yuasa we noticed entire blocks
of houses which, sometimes on one side and sometimes on two or
more sides, were railed off from the highway, at a short distance from
their fronts, by a barrier of galvanised iron about two feet and a half
high. At the time, this strange sight only aroused a momentary
curiosity. It was not until we were about leaving Hir-omura that we
learned the meaning of it all. In July of the previous Summer some
boatmen from Osaka had landed in Yuasa and had brought to the
villagers the dreadful bubonic plague. It had taken until the following
December for the authorities to stamp out the scourge effectually. By
this contrivance of an iron wall it was intended to trap the rats and
prevent their carrying the infection from house to house and from
street to street, before they could be killed. Aided by the barrier of
the little river, although there were several hundred cases in this
village, the other village, which was less than a mile away, wholly
escaped. In general, it is only by the most untiring and intelligent
diligence, extended into all the smaller places upon the coast and
into the remotest country districts, that Japan prevents the plagues
which are endemic in China, India, and Korea, from ravaging her
own land.
On the other side of the Hiro,—the stream which gives its name to
the village where Hamaguchi Gōryo lived, and across which he
made his famous jump when closely pursued by the incoming wave,
in 1855,—the “guests” were met by another “Welcome” arch, and
another yet longer array of school-masters and school-children.
Indeed, both villages, in the persons of as nearly all their inhabitants
as could get about, were obviously playing the part of welcoming
hosts. All doorways were crowded; all the streets along which the
jinrikishas passed were lined with citizens curious to see the “first-
arrived” foreigners in this part of Kishu.
On reaching his hospitable gateway we were met and welcomed by
Mr. K. Hamaguchi and his entire family, and were ushered into a
room which was such a surprise as can now be met by those who
have access to the houses of the cultivated and wealthy, even in
remote country districts of Japan. The floor of the large parlour or
drawing-room was entirely covered by a beautiful Chinese rug,
spread over the soft Japanese mats. In violation, to be sure, of the
native custom, but presumably for the delectation of his guests, a
temporary display of numerous art treasures had been arranged by
our host. Kakemonos painted by Enshu and other celebrated native
artists were hung upon the walls. Screens of the greatest artistic
interest and of almost priceless value were to be admired on every
hand. Nor were these art objects limited to the best specimens of
Japanese, or Chinese, or other Oriental workmen. Mr. K. Hamaguchi
in his travels around the world had made judicious selection of things
of beauty from many places. It was his boast, for example, that he
had collected flower-vases to represent the best work of a score of
different foreign countries.
This room, with its shoji drawn aside, looked out upon one of those
gardens which the Japanese are able, without exhausting a large
space, to make so very exquisite. In a darkened cage, which hung in
the verandah outside, a nightingale occasionally burst forth in song.
And when, after a dinner cooked in foreign style by a cook imported
from Osaka, the shoji were drawn and we were put to bed within a
small space curtained-off, in a bedstead brought expressly for this
purpose all the way from Tokyo, and covered with thickly wadded
Japanese futons of the winter variety, our only wish was that we
might have been allowed the much more comfortable but less
dignified spread of the same futons upon the floor of the large room,
with the sides still left open into the garden, so that we could breath
its delicious air, and go to sleep to the murmur of the fountain and
the song of the nightingale. But the return to the improved and more
elegant use of the better points in the art of comfortable and healthful
living, which were enforced before foreign customs were introduced
into the “Old Japan,” will come through the growth of understanding
and the added appreciation of a comfortable and healthful simplicity,
in the “New Japan.” Meantime we hope that the genuine and
delightful, if somewhat too elaborate, courtesies of host and guest
will not be wholly changed.
The next day was the time of work, the day for which the other days
of the rather lengthy but altogether delightful journey had been
undertaken. Its experiences were calculated to strengthen the
conclusions derived from all my other experiences during three
different visits to Japan,—namely, that no other nation is now, in
comparison with its resources, giving the same care to the
intellectual and ethical education of the common people. For Hiro-
mura, the reader will remember, is an obscure village, not even
mentioned in the guidebooks, some twenty-five miles from the
nearest railway station, and never, according to the testimony of their
leading citizen, visited by foreigners before.

“YOU CANNOT MOCK THE CONVICTION OF MILLIONS”

But the day was also calculated to impress yet more deeply another
characteristic of the social and public, as well as of the domestic, life
of Japan. The spirit of Hamaguchi Gōryo was everywhere in the air.
And here is where Mr. Hearn shows his insight into, and his
appreciation of, a momentous truth. It is, indeed, a truth which
cannot be argued with the Westerner,—easily or without
embarrassment, for lack of a sufficient standing upon common
ground. It is a truth which must be profoundly felt. Japan, perhaps
more than any other civilised nation, is constantly under the
prevailing influence of a belief in what Mr. Hearn is pleased—not
altogether aptly—to call “ghosts.” These are the ghosts—I should
rather say, the felt spiritual presences—“of great warriors and heroes
and rulers and teachers, who lived and loved and died hundreds or
thousands of years ago.” As he says truly: “You cannot mock the
conviction of forty (now more than fifty) millions of people while that
conviction thrills all about you like the air,—while conscious that it is
pressing upon your psychical being just as the atmosphere presses
upon your physical being.” Even to-day, in the school-rooms and
university halls and public playgrounds of the children and youth of
Japan, it is not the trophies of some individual player or team of
athletes, but the mottoes and injunctions and other relics of the great
and the good, not only of the present, but also and chiefly of the
older, and the most ancient times, which excite their feelings of pride
and emulation.
Soon after nine o’clock Mr. Takarayama, the head-master, came to
conduct us to the school. Our way there was lined with villagers,
some of them with chubby babies strapped upon their backs or held
aloft in the arms, and all eager to see the wonderful sight. A yet more
beautiful arch than any we had before seen had been constructed by
the pupils at the entrance to the school-grounds. Inside the gateway,
too, was a most elaborate system of decorations, arranged by
displaying many flags of all nations which had been laboriously
painted by the same youthful hands. Teachers and scholars made a
thick-set avenue by which the building where the addresses were to
be given must be approached. This and all the other buildings, now
newly completed but already paid for, stand within grounds that are
ample for the future expansion of the school. The site is lovely. It is a
gently sloping ground, with the water in sight. The bay which washes
its feet is called “Nagi,” or “The Peaceful”; and it is rightly named.
The morning exercises, including the address by the foreign Sensei,
or Teacher, were to be devoted to the pupils and patrons of the
school; while the afternoon meeting was more particularly intended
for the several hundred teachers in the district, many of whom had
come by jinrikisha or, more often, on foot, from twenty and even
thirty miles away. But even the morning’s programme was sufficiently
elaborate to impress the visitors from surrounding parts with the
great importance of an occasion so unique. A study of the somewhat
quaint translation of the Japanese original disclosed the following
particulars, duly itemised and correctly numbered:
(1) Visiting the recitation rooms; (2) Salutation (all together); (3)
introduction (the Principal); (4) singing a welcome song (the pupils);
(5) address of welcome (a pupil); (6) sketch of the school (a pupil);
(7) welcome (Mr. K. Hamaguchi); (8) Address (Professor Ladd); (9)
Thanks (the Principal); (10) singing of a school song; (11)
(dismission).
Under certain circumstances it is no small advantage not to be
familiar with the language in which you are being addressed. This is
especially true when one is either excessively praised or excessively
blamed and denounced. In this way the foreign speaker at this
morning gathering in Hiro-mura was spared the temptation which
would have accompanied the knowledge that the youth who gave
the address of welcome—No. 5 upon the programme—was
comparing his fame to Fuji and his graciousness and charm to the
cherry-blossoms on Mount Yoshino; but this is what the translation of
the address subsequently revealed. Such things, however, were
commoner and more congenial to the poetic license of the Old
Japan. Now, in spite of certain attempts at modernising, this part of
Kishu remains much the same as of old; and so, both the youthful
reader of the words and the adult hearers of them were quite
properly solemn and unmoved by the sight and fragrance of such
flowers of flattery.
Nature, however, was preparing to give the audience another sort of
reminder of the days and deeds of Hamaguchi Gōryo. For the
foreign guest had scarcely heard his last sentences interpreted by
the head-master, when a loud explosion, followed by rumbling noises
like those which would be made by scores of huge ten-pin balls
rolling over a wooden alley, startled us all. It was within a few
seconds of noon; and the watches of those who had them came out
promptly in order that their owners might note the exact time. The
lady of the foreign guests indeed interpreted it all to mean that the
noon-gun had just been fired. She was alone in this impression;
every one else knew that there was no noon-gun to be fired, within
many miles; but that some stratum of rock under the neighbouring